Search

To treat lower-extremity osteomyelitis secondary to trauma, bone and soft tissue can be grafted at the same time using microsurgical techniques. We investigate the use of chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap to reconstruct bone and soft-tissue defects of the lower leg due to osteomyelitis. Ten patients with lower-extremity bone and soft-tissue defects due to osteomyelitis were treated. Vascularized scapular bones were raised on the angular branch of the thoracodorsal artery. Latissimus dorsi myocutaneous flaps were elevated simultaneously to reconstruct the soft tissue defects. All patients tolerated the procedure well. One patient developed an early venous thrombosis, which was successfully treated by thrombectomy. Mean follow-up time was 7 years and 8 months. Bone union without refracture was observed in all patients. The mean time required for bone union after surgery was 13.5 weeks. Donor-site morbidity was minimal. Chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous are safe and effective in the repair of lower-extremity bone and soft-tissue defects caused by osteomyelitis.

Autogenous calvarial bone grafts have been widely used in craniofacial reconstruction following trauma, congenital anomalies, and head and neck tumors. In cases of late restoration of a collapsed cranial vault, an extradural dead space is occasionally observed which might cause infection and grafted bone absorption. The combined use of a split calvarial bone graft and an omental flap has been an effective technique for treating complicated cranial defects. The omental flap eliminates the extradural dead space between the grafted calvarial bone and the scarred dura, and provides an acceptable vascular bed for grafted bone. The authors report this technique for complex cranioplasties in two cases, with good cosmetic results.

The authors' experiences with 34 free lower TRAM flap transfers, in which 19 primary reconstructions and 15 secondary reconstructions were successfully achieved, are reviewed. The free TRAM flap yielded better results than the pedicled TRAM flap in cases where reconstruction of the infraclavicular and anterior axillary areas, as well as of the breast mound itself, was required.

A new experimental model is presented, using isohistogenic Lewis rats and microsurgical techniques. Transplantation of the head and forelimbs of the infantile rat was done to the groin of an adult rat. The goal was to study the effects of ischemia on brain tissue. This model also proved useful for other experiments in studies of facial and cranial bone growth. The model presented proved efficient for the study goals, and long-term experiments were possible. The maximum ischemia time tolerated by brain tissue was found to be somewhere between 60 min and 120 min.